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After Mastectomy, More Women Choosing Breast Reconstruction

Rise linked to increase in double mastectomies; strong regional differences shown

March 26, 2014

Written By Robin Warshaw
Reviewed By Steve R. Martinez, MD, MAS, FACS

The number of women having breast reconstruction after mastectomy increased greatly from 1998 to 2007, a recent large-scale study reveals. Significant differences in the use of breast reconstruction were noted depending on geographic region, breast cancer treatment and other factors.  

Background and Reason for the Study

Mastectomy, surgical removal of the breast, may be performed on one or both breasts to treat breast cancer or prevent it in high-risk women. Breast reconstruction is a surgery to rebuild the breast shape using a saline or silicone implant, or a woman’s own transferred tissue. A plastic surgeon commonly performs the surgery, which is optional for women treated with mastectomy. Women who do not have breast reconstruction after mastectomy may choose to wear a breast form, a kind of prosthesis, under their clothing.

Breast reconstruction usually happens in a series of steps. Immediate reconstruction begins at the same time as mastectomy. Delayed reconstruction starts at a later date than mastectomy.

Earlier research showed that breast reconstruction can have a positive psychosocial impact on women. The Women’s Health and Cancer Rights Act of 1998 requires all medical insurance companies providing mastectomy coverage to also cover all stages of reconstruction of the affected and opposite breast, if desired. 

The researchers of the current study wanted to learn about the use of breast reconstruction over time.They explored whether there were factors influencing use including geographic location, the number of plastic surgeons available or type of cancer treatments women received.    

Study Structure

Researchers gathered data from a nationwide database of medical claims from employer health insurance plans. They identified 20,560 women who had mastectomies over a 10-year period. From that group, they found 11,310 who had immediate or delayed reconstruction within 2 years of breast cancer treatment.

Data were analyzed to assess characteristics of reconstruction and how often it was used. The number of plastic surgeons by region and household income were drawn from other sources and analyzed with the health insurance data.

Findings

Reconstruction use rose over time, from 46 percent of women having mastectomies in 1998 to 63 percent in 2007.

  • Procedures using implants increased, while tissue (autologous) reconstruction decreased.

Double (both breasts, or bilateral) mastectomies also increased greatly, from 3 percent of mastectomies in 1998 to 18 percent in 2007. The study showed

  • 76.2 percent of women having double mastectomies had reconstruction
  • 51.9 percent of women with single (one breast) mastectomies had reconstruction

Younger women were more likely than older women to choose reconstruction. The percentage of reconstruction use by age at diagnosis was

  • younger than 40 – 75.7 percent
  • 40-49 – 66.7 percent
  • 50-59 – 48.3 percent
  • 60 and older – 33.4percent

Radiation treatment may cause physical changes that affect reconstruction options. Only 40.9 percent of women having radiation therapy also had reconstruction. Those women were more likely to choose tissue reconstruction than implants.

The researchers found use of reconstruction varied greatly by region. They noted “significant associations” between rates of reconstruction use and the number of plastic surgeons per 100,000 residents in an area. The more surgeons in a region, the greater the reconstruction use.

Women living in counties with higher median household incomes also were more likely to have reconstruction — perhaps due to more practicing plastic surgeons in the area.

What This Means for You

It can be hard to think about breast reconstruction when you’ve just been diagnosed with breast cancer. This study revealed many factors that might affect your decision.

Think about whether you want reconstruction and discuss your options with your healthcare team. If you will have radiation treatment, talk with your radiologist and plastic surgeon about reconstruction, how it should be scheduled and what your choices might be. Ask your plastic surgeon to see photos of reconstructed breasts and talk with women who’ve had the surgery you’re considering.

If you are having trouble finding a plastic surgeon in your area, ask your oncologist or breast surgeon to refer you to one or contact the American Society of Plastic Surgeons.

Be sure to check with your health insurer about your coverage and out-of-pocket expenses for reconstruction. If you are underinsured or have no insurance, you may find help through MyHope Chest.

Jagsi, R, Jiang, J, Momoh, AO et al. Trends and Variation in Use of Breast Reconstruction in Patients with Breast Cancer Undergoing Mastectomy in the United States. Journal of Clinical Oncology. 2013; doi:10.1200/jco.2013.52.2284

Denver, CO  ·  September 13, 2014

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